{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T13:43:43Z","timestamp":1789825423382,"version":"4.0.1"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,7,16]],"date-time":"2024-07-16T00:00:00Z","timestamp":1721088000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,7,16]],"date-time":"2024-07-16T00:00:00Z","timestamp":1721088000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The randomized TOmosynthesis plus SYnthesized MAmmography (TOSYMA) screening trial has shown that digital breast tomosynthesis plus synthesized mammography (DBT\u2009+\u2009SM) is superior to digital mammography (DM) in invasive breast cancer detection varying with breast density. On the other hand, the overall average glandular dose (AGD) of DBT is higher than that of DM. Comparing the DBT\u2009+\u2009SM and DM trial arm, we analyzed here the mean AGD and their determinants per breast density category and related them to the respective invasive cancer detection rates (iCDR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>TOSYMA screened 99,689 women aged 50 to 69 years. Compression force, resulting breast thickness, the calculated AGD obtained from each mammography device, and previously published iCDR were used for comparisons across breast density categories in the two trial arms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 196,622 exposures of 49,227 women (DBT\u2009+\u2009SM) and 197,037 exposures of 49,132 women (DM) available for analyses. Mean breast thicknesses declined from breast density category A (fatty) to D (extremely dense) in both trial arms. However, while the mean AGD in the DBT\u2009+\u2009SM arm declined concomitantly from category A (2.41\u2009mGy) to D (1.89\u2009mGy), it remained almost unchanged in the DM arm (1.46 and 1.51\u2009mGy, respectively). In relative terms, the AGD elevation in the DBT\u2009+\u2009SM arm (64.4% (A), by 44.5% (B), 27.8% (C), and 26.0% (D)) was lowest in dense breasts where, however, the highest iCDR were observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Women with dense breasts may specifically benefit from DBT\u2009+\u2009SM screening as high cancer detection is achieved with only moderate AGD elevations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical relevance statement<\/jats:title>\n                    <jats:p>TOSYMA suggests a favorable constellation for screening with digital breast tomosynthesis plus synthesized mammography (DBT\u2009+\u2009SM) in dense breasts when weighing average glandular dose elevation against raised invasive breast cancer detection rates. There is potential for density-, i.e., risk-adapted population-wide breast cancer screening with DBT\u2009+\u2009SM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>\n                            <jats:italic>Breast thickness declines with visually increasing density in digital mammography (DM) and digital breast tomosynthesis (DBT).<\/jats:italic>\n                          <\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>\n                            <jats:italic>Average glandular doses of DBT decrease with increasing density; digital mammography shows lower and\u00a0more constant values.<\/jats:italic>\n                          <\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>\n                            <jats:italic>With the smallest average glandular dose difference\u00a0in dense breasts, DBT plus SM had the\u00a0highest difference in invasive breast cancer detection rates.<\/jats:italic>\n                          <\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-024-10847-9","type":"journal-article","created":{"date-parts":[[2024,7,16]],"date-time":"2024-07-16T11:00:35Z","timestamp":1721127635000},"page":"166-176","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Radiation exposure and screening yield by digital breast tomosynthesis compared to mammography: results of the TOSYMA Trial\u00a0breast density related\u00a0"],"prefix":"10.1007","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2770-7765","authenticated-orcid":false,"given":"Alexander","family":"Sommer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanie","family":"Weigel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans-Werner","family":"Hense","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim","family":"Ger\u00df","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronika","family":"Weyer-Elberich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Kerschke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elke","family":"Nekolla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Horst","family":"Lenzen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter","family":"Heindel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the TOSYMA Screening Trial Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter","family":"Heindel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanie","family":"Weigel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim","family":"Ger\u00df","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans-Werner","family":"Hense","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerold","family":"Hecht","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Sommer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Horst","family":"Lenzen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg","family":"Czwoydzinski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,7,16]]},"reference":[{"key":"10847_CR1","first-page":"209","volume":"71","author":"H Sung","year":"2021","unstructured":"Sung H, Ferlay J, Siegel RL et al (2021) Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. 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Stefanie Weigel: works for the National Reference Center Mammography M\u00fcnster, a third-party\u2013funded project at the University of M\u00fcnster and the associated Reference Screening Unit; involved in the educational courses of the Reference Center and received payments for lectures; unpaid member of the Deutsche R\u00f6ntgengesellschaft, AG Mammadiagnostik, and Deutsche Gesellschaft f\u00fcr Senologie. Walter Heindel: runs the National Reference Center Mammography M\u00fcnster, a third-party\u2013funded project at the University of M\u00fcnster and the associated Reference Screening Unit; involved in the educational courses of the Reference Center Mammography M\u00fcnster and received payments for lectures. Hans-Werner Hense: involved with the educational courses of the Reference Center and received payments for lectures. Joachim Ger\u00df: consulting fees from Dr. August Wolff, Ecker\u2009+\u2009Ecker, QUIRIS Healthcare, TESARO Bio; honoraria from Roche Pharma and TESARO Bio; payment for TOMAHAWK study, University Clinics Schleswig-Holstein, Campus L\u00fcbeck, Germany and Ruxo-BEAT trial, RWTH Aachen University, Germany. Laura Kerschke: no relevant relationships. Veronika Weyer-Elberich: no relevant relationships. Horst Lenzen: works for the National Reference Center Mammography M\u00fcnster, a third-party\u2013funded project at the University of M\u00fcnster and the associated Reference Screening Unit; works for CO.RA Consulting Radiologie GbR; involved in the educational courses of the Reference Center and received payments for lectures, consulting for the \u00c4rztekammer Westfalen-Lippe. Elke Nekolla: no relevant relationships.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Mr. Joachim Ger\u00df (author) kindly provided statistical advice for this manuscript as well as Ms. Laura Kerschke (author)\u00a0and Ms. Veronika Weyer-Elberich (author). Institute of Biostatistics and Clinical Research, University of M\u00fcnster, M\u00fcnster, Germany.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent was obtained from all subjects (patients) in this study.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Institutional Review Board approval was obtained, and the approving bodies were: (1) Ethics Commission M\u00fcnster, Gartenstra\u00dfe 210\u2013214. 48147 M\u00fcnster, Germany; (2) Ethics Commission, \u00c4rztekammer Niedersachen, Karl-Wiechert-Alle 18\u201322, 30625 Hannover, Germany; (3) Ethics Commission, Artzekammer Nordrhein, Tersteegnstra\u00dfe 9, 40474 D\u00fcsseldorf, Germany. The ethics votes have been attached.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}},{"value":"Some study subjects or cohorts have been previously reported: Heindel W et al [\n                      \n                      ]; Weigel S et al [\n                      \n                      ]; Weigel S et al [\n                      \n                      ]; Weigel S et al (2024) Breast cancer screening with digital breast tomosynthesis: is independent double reading still required? R\u00f6Fo, publication 2024 (\n                      \n                      ).","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}